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DIAGNOSIS AND CORRECTION OF FUNCTIONAL DISORDERS OF LIVER AND LUNG IN PATIENTS WITH SUBDIAPHRAGMATIC LIVER ECHINOCOCCOSIS
30.10.2015

Rafikov S.R., *Mahmadov F.I., *Kurbonov K.M., *Rahimov A.R.

DIAGNOSIS AND CORRECTION OF FUNCTIONAL DISORDERS OF LIVER AND LUNG IN PATIENTS WITH SUBDIAPHRAGMATIC LIVER ECHINOCOCCOSIS

Department of Surgical Diseases of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Surgical Diseases №1 of the Tajik Medical State University named after Abua- li-ibn-Sino

Aim.Improvement of results of treatment of subdiaphragmaticechinococcosis of liver and its complications.

Materials and methods. The present research is based on the analysis and treatment of 76 patients with hepatic echinococcosis of subdiaphragmatic location. The vast majority were persons older than 40 years. There were 33 males (43,4%) and 43 women (56,6%). Complicated forms of echinococcosis was observed in 63,1% (n=48) patients (abscess-27, a breakthrough in the bile way – 21).

Results.Echinococcosis of the liver accompanied by significant destruction of hepatocytes, a violation of indicators of the level of proinflammatory cytokines and nitric oxide, especially in the complicated course and subdi-aphragmatic location, indicating that altered functions of liver and lungs. With the growth of volume of hydatid cysts in the subdiaphragmatic space and in long-term course of the disease violated ventilation and gas exchange function of the lungs.

Conclusion. To patients with hepatic echinococcosissubdiaphragmatic localization advisable to conduct in the preoperative period antihypoxic therapy to significantly improve functional state of the liver and lungs.
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EFFECTIV TREATMENT OF URINARY TRACT INFECTIONS IN PRIMARY CARE IN THE PRACTICE OF FAMILY PHYSICIAN
30.10.2015

Nazirova N.K., Mirzoeva Z.A., Vositzoda Z.F.

EFFECTIV TREATMENT OF URINARY TRACT INFECTIONS IN PRIMARY CARE IN THE PRACTICE OF FAMILY PHYSICIAN

Department of Family Medicine of the State Educational Establishment «Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan»

Aim. Evaluate the effectiveness of schemes treatment of urinary tract infections UTI based on the principles of evidence-based medicine.

Materials and methods. We observed 28 patients with UTI, with average age 23,3±2,4 years. Children and adolescents comprised 42,9% (12 people), adults – 57,1% (16 people), among them women – 60,7%, men – 39,3%. Methods applied: clinical and statistical.

Results. Among those who were diagnosed UTI first established in 11 people (39,3%): acute cystitis observed among 63,6% (7 people), acute pyelonephritis – 36,4% (4 people). Patients with recurrent episodes of UTI comprised 60,7% (17 people): 58,8% (10 people) with cystitis, 41,2% (7 people) with pyelonephritis. 71,4% of cases of recurrent episodes of pyelonephritis were observed in patients with urolithiasis.UTI was treated with consideration of gender, age and diagnosis. Children younger than 12 years with cystitis and pyelonephritis received amoxicillin in combination with clavulanic acid 20-40 mg/kg per day in 3 divided doses for 5 (7-10) days. All patients older than 12 years received 100 mg of nitrofurantoin 2 times a day for 5 days (level of evidence A) or 500 mg of ciprofloxacin (alternative) 2 times a day 3-5 (7-10) days. Patients with recurrent UTI after adequate therapy and bacterial eradication were received long-term prophylaxis with nitrofurantoin, as 50 or 100 mg at bedtime for 6-12 months. As a result of treatment, based on evidence-based medicine, we observed positive dynamics of clinical and laboratory manifestations of UTI.

Conclusion. There is a necessity of strict adherence to the recommended schemes in accordance with the conclusive data, and avoidance of excessive use of antimicrobial drugs and use antibiotics without evidence.
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PHYSICAL DEVELOPMENT AND GYNECOLOGICAL STATUS AMONG GIRLS AND WOMEN WITH HELMINTH INFECTIONS WHILE IODINE DEFICIENCY DISEASES
30.10.2015

Muhamadieva S.M., Sabirovа G.A., Pulatova A.P.

PHYSICAL DEVELOPMENT AND GYNECOLOGICAL STATUS AMONG GIRLS AND WOMEN WITH HELMINTH INFECTIONS WHILE IODINE DEFICIENCY DISEASES

Department of Obstetrics and Gynecology of the State Educational Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

State Establishment “Scientific-Research Institute of Obstetrics, Gynecology and Perinatology”

Aim. To study the physical development and frequency of helminth infections among girls of pubertal age with iodine deficiency diseases.

Materials and methods. The complex observation of 160 girls in the age of 10-16 who turned to the children’s gynecology department and to consultation and diagnostics polyclinic of Scientific and Research Institute of Obstetrics, Gynecology and Perinatology was conducted: anthropometrical indicators, index of body mass (Brey), for evaluation of mammary glands development the Tanner’s formula was used. All of the girls went through clinical analysis of blood and urine, flora smear, analysis of faeces for helminth eggs and lamblia cysts, scrape for enterobiasis, ELISA (immunoglobulins G and M) to antigens lamblia in blood, biochemical analysis of blood with evaluation of activity of Alanine Aminotransferase, AST, Ultrasound Examination of thyroid gland and organs of abdominal cavity and pelvis minor.

Results. Iodine deficiency diseases (IDD) and helminth infections form low index of health of girls and women of pubertal age. Combination of anemia and goiter is in 92,8% of patients, pyelonephritis – 60,0%, cold diseases in anamnesis in 99,9%, each second had disorder of period cycle. Physical development of girls of main group was behind the control group: average height of patients was 145,6±1,4 cm. The average index of Brey was 17,5 which corresponds to low border norm. Delay of sexual development had 21,4%, whereas in control group this indicator was 1,7 times lower (37,1%).

Conclision. Helminthic infections effect on the physical development and formation of reproductive function of girls and women which have iodine deficiency diseases. Use of modern technologies will allow quickly identify this category of patients and heal them.
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FEATURES OF PSYCHOSOMATIC MANIFESTATIONS AT ACUTE MYELOBLASTIC LEUKEMIA
30.10.2015

Mustafokulova N.I., Ganieva M.P., Ahunova N.T., Boronov J.B.

FEATURES OF PSYCHOSOMATIC MANIFESTATIONS AT ACUTE MYELOBLASTIC LEUKEMIA

Department of Internal Diseases №3 of Tajik State Medical University named after Abuali-ibn-Sino Department of Therapy with a Course of Gerontology of State Educational Establishment «Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan»

Aim. Rate features of psychosomatic manifestations and quality of life of patients at acute myeloblastic leukemia.

Materials and methods. The study protocol includes prospective and perspective (from 2009 to 2014 years) observation of 140 patients with acute and chronic myeloblastic leukemia. The average age is 35,9±0,7 years. Male – 62 (45,9%), wom¬en – 78 (54,1%). Of which 70 patients amounted to 1 group with acute myeloleukemia, 2 group – 70 patients with chronic myeloleukemia. Both groups the determination of the level of psycho-emotional sphere with the help of ospital Anxiety and Depression Scale (HADS) was conducted. To assess the quality of life and efficiency of rehabilitation activities in patients with acute leukemia the use of SF-36 questionnaire was provided. The calculation was made according to special transformation of scales. Evaluation was performed on a 100-point system.

Results. Study of patients by anxiety and depression scale (HADS) was performed on the second or third day admission to the hospital and again two weeks after the therapy. The test results on the scale of HADS led to the conclusion of reliable differencesthe of level of anxiety in both groups: 1 group with high levels of anxiety included 6 patients (12 points) and 2 group at high risk of anxiety included 12 patients. Subclinically expressed depression on a scale of HADS detected in 8 patients. In patients with chronic myeloblastic leukemia subclinically expressed depression detected in 13 patients (8 points). At a combination of anxiety and depression on a scale of HADS in 1 group more number of patients – 39 (14/14), in the second group – 31 patients (14/13). Subclinically expressed stage in 1 group observed in 3 (10,9), in 2 group – in 10 (19/9 points), which is high in both groups. It is established that the quality of life of patients with acute and chronic myeloleukemia, determined using the SF-36 questionnaire significantly reduced. After 4 weeks of using assigned sedative therapy showed a significant (p <0,05) improvement in the quality of life of patients with acute and chronic myeloleukemia. Conclusion. Stress and psychological disorders in patients with acute myeloid leukemia accompanied by high levels of a combination of anxiety and depression, clinically significant in 55,7%. Psychophysiological violations identified in patients with chronic myeloid leukemia in 44,3% of cases. In order to improve the quality of treatment at depressive states, recommended using of sedative drugs, tranquilizers, at high performance - with using of programs of antidepressants that increase the educational level of patients: holding the conversation, lectures and autogenous training.
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IMPROVEMENT OF CLASSIFICATION OF BILIOUS PERITONITIS
30.10.2015

Muminov S., *Kurbonov K.M., Rasulov N.A., *Kayumov A.A.

IMPROVEMENT OF CLASSIFICATION OF BILIOUS PERITONITIS

Department of Surgery of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Surgical Diseases №1 of the Tajik Medical State University named after Abuali-ibn- Sino

Aim. Improve and introduce classification of bile peritonitis.

Materials and methods. For a basis of this research the experience of complex diagnosis and surgical treatment of 87 patients with bilious peritonitis was put. Patients treated in the City Clinical Hospital of Emergency Medical Care Dushanbe. Also, evidence to date classification of peritonitis, and in particular, the bilious was analyzed and studied.

Results. The dinical manifestation of bilious peritonitis largely depended from reasons of disease arising and severity of endotoxemia. Based on the study and review of available clinical data the clinical classification of bilious peritonitis was developed. It would greatly optimize the further tactics and thus improve results of treatment.

Conclusion. Conducted operations on the biliary tract are often associated with great technical difficulties which require from surgeon of relevant experience in the field of hepato-biliary surgery. So the given classification would greatly simplify and improve further tactics of selection of operative intervention volume. A significant danger is presented by a septic symptoms which indicate the need for timely selection of treatment of this patients.
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MINIMALLY INVASIVE SURGERY OF LIVER ECHINOCOCCOSIS
30.10.2015

Gulmuradov T.G, Amonov Sh.Sh, *Prudkov M.I., Sangov D.S.

MINIMALLY INVASIVE SURGERY OF LIVER ECHINOCOCCOSIS

Department of Cardiovascular and Plastic Surgery of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*State Budgetary Educational Institution of Higher Professional Education Ural State Medical University, Ekaterinburg, Russia

Aim. Improving results of surgical treatment of hepatic echinococcosis by applying minimally invasive technology.

Materials and methods. Under the supervision during the period 2002-2013 there were 149 patients with hepatic echino-coccosis. From them 52 were examined at the Department of Surgical Diseases advanced training faculty and postgraduate training. The remaining 97 patients – in endosurgical department of the Republican Scientific Center for Cardiovascular Surgery in Dushanbe. Among them were men 63 (42,2%) and 86 women (57,8%). In 105 (70,4%) patients echinococcal cysts were located in the right liver lobe (18 – V; 24 – VI; 31 – VII; 28 – VIII), in the left lobe – 44 (29,6%) of 2 – I; 12 – II; 19 – III; 13 – IV segments. According to the size and scope of the cysts distinguish between: medium to 10 cm – 80 patients, large 20 cm – 46 patients and giant than 20 cm – 23 patients. The average size of cyst was 102,77±3,7mm (46-280 mm). From the 149 patients 42 patients underwent echinococcectomy of the traditional approaches, 40 patients underwent laparoscopic echinococcectomy when echinococcus cyst localized to visually accessible segments of the liver S III, IV, V, VI; 67 operations performed minilaparotomiya access using a set of tools “Mini-Assistant”.

Methods of surgical treatment of echinococcal cysts of the liver involves surgical access, puncture and aspiration of the cyst contents, opening the cyst and the revision of its cavity, cyst processing by adsorbed 33% solution of hydrogen peroxide (perhydrol) and the elimination of residual cavity (wide fenestration, in a number of cases a large portion of tamponade gland, external drainage with low vacuum aspiration).

Results. Postoperative complications were observed in 9 (21,4%) of 42 patients operated by conventional methods. Of the 107 patients operated using minimally invasive technology (mini-access and laparoscopically), complications were observed in 14 (13,1%) patients. Especially favorable postoperative course was after the intervention of the small incisions. Case of an expression enteroparesis and systemic were no complications.

Conclusion. Using minimally invasive techniques allow to improve results of surgical treatment of liver echinococcosis. Minimal trauma, high economic efficiency are the main advantages of these methods.
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SOME FEATURES OF STI/HIV DISSEMINATION IN THE MODERN SOCIAL AND ECONOMIC CONDITION
30.10.2015

Bobohodjaeva M.O., *Ahmedov A., *Kasymova M.K.

SOME FEATURES OF STI/HIV DISSEMINATION IN THE MODERN SOCIAL AND ECONOMIC CONDITION

Department of Obstetrics and Gynecology of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

*Department of Public Health, Economics, Management with a course of medical health statistics of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.Definition of features STI/HIV transmission in modern social and economic conditions.

Materials and methods.Conducted a sociological survey of 400 workers, providing sexual services (SW) in Dushanbe. The survey was anonymous, voluntary on the basis of an oral informed consent. The questionnaire included questions that reflect the issues of social characteristics, sexual and reproductive behavior and health of the PC and users of their services.

Results. On growth and spread of STI / HIV infection in a certain way affect behavioral factors of SW. In epidemiological process involved not only persons with risky behavior (drivers, businessmen), as well as students of secondary and higher educational institutions, employees of state agencies, including foreign nationals. Foregoing facts explain such fast spread of STI / HIV among the population. During the days of SW had from 2 to 5 sexual partners – 47,8% of respondents; from 6 to 9 – 20,5% SW, 10 and more – 11,7%, 1 sexual partner were 17,3%, 2,7% did not answer. The respondents have taken alcohol at least once a week – 16,0%, several times a week – 12,0%. The proportion of drug users among sex workers was 2,9%. Sex workers who were injecting drug users do not use disposable syringes. 37,0% occasionally use condoms, and only 12,0% – permanently.

Conclusion. Due to the wide spread of STI / HIV, behavior of SW has become one of the most important indicators of risk because it reflects the potential danger of mass infection in the community.
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POSITIVE INFLUENCE OF SORBITOL IN PATIENTS WITH CHRONIC RENAL FAILURE
30.10.2015

Bobieva N.H., Gadoev S.H., Subhonova Z.I., *Sunatulloev D.S.

POSITIVE INFLUENCE OF SORBITOL IN PATIENTS WITH CHRONIC RENAL FAILURE

Department of Internal Disease № 3 of the Tajik Medical State University named after Abuali-ibn-Sino

*Department of Therapy of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.To estimate actions of sorbitol in combination with enterosorbents on gastrointestinal tract in the complex treatment of chronic renal failure.

Materials and methods. The study included 40 patients with chronic renal failure. Diagnosis and assessment of severity of uremia was conducted by determination of glomerular filtration rate (the level of urea and creatinine in blood), the A / D profile and the degree of edemas.

Results. In patients on background of reception of sorbitol 10-15 days earlier than in the control group, marked decrease in the level of nitrogenous wastes in the peripheral blood (urea, creatinine), reduction of edemas, reduction of hypertension. Reception of sorbitol accompanied by a decrease symptoms of uremic intoxication and improvement of the patient. Improvement comes after 7-10 days of treatment. This is manifested in decrease of pruritus, nausea and vomiting, headache and decrease in levels of nitrogenous wastes in the peripheral blood. Wellness at reception of sorbitol saved from 1 to 6 or even 12 months.

Conclusion. The use of sorbitol in combination with other enterosorbents significantly complements traditional dialysis therapy, hemodialysis pushing the starting date.
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ULTRASOUND SCANNINGAS AN EFFECTIVE METHOD OF DIAGNOSING OF EXUDATIVE PLEURISY IN CHILDREN
30.10.2015

Bahodurov J.T., Ibodov H.I., Rofiev R.R., Asadov S.K., Nurov M.S.

ULTRASOUND SCANNINGAS AN EFFECTIVE METHOD OF DIAGNOSING OF EXUDATIVE PLEURISY IN CHILDREN

Department of Pediatric Surgery, Anesthesiology and Reanimatology of the State Education Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim.Determination of the value of ultrasound scanning in the diagnosis of lung diseases such as exudative pleurisy in children.

Materials and methods. Investigated the clinical and laboratory, radiographical, CT, MRCI and ultrasound scan data of 76 patients with a diagnosis of pleural effusion in age from 1 month to 15 years.

Results. Based on the clinical and laboratory, radiographical, MRCI and ultrasound scan data of 76 patients in 3 diagnosed lung cancer, in 5 specific process, and in rest 68 children set pulmonary-pleural form of bacterial destructive pneumonia. At bacteriological research in 15 patients sown staphilococcus, in 6 – streptococcus, and in 7 – klebsiella. In other 43 cases, microorganism growth is not detected. At ultrasound examination of presumptive defeat zones lung tissue was visualized as a set of cellular structures or destructive changes, and at a depth of 0,5-0,9 cm from pleural sheets started to delaminate planar structures formed vessels and bronchial tubes. At empieme of pleural cavity the presence of echogenic suspensions was revealed, the maximum thickness of the parietal pleura was 5,2±0,3 mm, as opposed to other types of pleuritis. A reliable signs of metastatic pleuritis were: homogeneous pleural contents, the minimum thickness of parietal pleura 3,5±0,3 mm.

Conclusion. Comparison results of ultrasound examination of pleuritis with data morphological research, obtained at puncture biopsy of pleura controlled by ultrasound examination, showed their high correlation in identifying of etiology of pleural effusion. Using of duplex ultrasound scan at complex ultrasound examination allowed to reveal flow in the formations subpleural located in lung parenchyma of tumor etiology, in contrast to formation of inflammatory genesis.
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STUDY OF INJURIES STRUCTURE AND IMPROVEMENT OF PREVENTATIVE ACTIVITY OF FAMILY PHYSICIANS IN THE CITY HEALTH CENTER №1 C. DUSHANBE
30.10.2015

AshurovZ.Ya., Mirzoeva Z.A., Davlyatova D.D.

STUDY OF INJURIES STRUCTURE AND IMPROVEMENT OF PREVENTATIVE ACTIVITY OF FAMILY PHYSICIANS IN THE CITY HEALTH CENTER №1 C. DUSHANBE

Department of Family Medicine of the State Educational Establishment “Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan”

Aim. Analyze the traumatism in the city health center №1 c. Dushanbe, evaluate its structure, suggest ways of preventing in practice of family doctor.

Materials and methods. For the analysis of traumatism in the city health center №1 c. Dushanbe statistical data of emergency station №3 at city health center №1 c. Dushanbe of 2012 -2013 years were used.

Results. Concerning street traumatism in 2012 1937 persons (40,4%), in 2013 – 1997 (38,4%) appealed. In 2013 decrease of cases of street traumatism on 2% is observe. Concerning home traumatism for medical care 2854 – 59,6% of patients, and in 2013 – 2495 – 47,9% (decrease 11,7%) appealed. 459 pupils received injuries at school (5,2%) in 2012, in 2013 – 241 (4,6%). Sports injuries in 2012 accounted 459 cases (9,5%), in 2013 – 388 (7,4%) (positive dynamics). Over the wound in 2012 1771 children (37,0%), in 2013 – 1440 (27,6%) appealed. Open fractures in 2012 included 8 cases (0,1%), in 2013 – 11 (0,2%) (increase on 0,1%); closed – 1568 (32,7%) in 2012 and 1275 (24,5%) in 2013. Dislocations in 2012 reached 281 case (5,6%), in 2013 – 205 (3,9%). With burns in 2012 18 persons (7,3%), in 2013 – 186 (3,7%), of animals bites 369 patients (7,1%) in 2012 and 320 (6,1%) in 2013 addressed. Conclusion. At the present time, there are serious problems in the prevention of traumatism due to the low level of education of the population, poor public and society awareness.
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